Cellulitis clinical presentation

Patient outcomes rely on the clinicians ability to recognize NF early in the course of disease. This is often difficult because early disease tends to be indistinguishable clinically from cellulitis. I The clinical presentation of NF is presented in Table 70-4. 

Early Skin is erythematous, edematous, and warm the clinical presentation is similar to that of cellulitis. 

The clinical presentation differs from cellulitis in that the lesion has clearly demarcated raised margins. 

The goal of therapy of acute bacterial cellulitis is rapid eradication of the infection and prevention of further complications. Antimicrobial therapy of bacterial cellulitis is directed against the type of bacteria either documented or suspected to be present based on the clinical presentation. Local care of cellulitis includes elevation and immobilization of the involved area to decrease swelling. Cool sterile saline dressings can decrease pain and can be followed later with moist heat to aid in localization of the cellulitis. Surgical intervention (incision and drainage) as a mode of therapy is rarely indicated in the treatment of cellulitis. 

A 56-year-old man presents to the emergency room with complaints of right lower leg pain and redness. Examining his leg, you notice that he has erythema and edema extending from his ankle to proximal tibia. The area feels warm. On questioning, the patient states that the redness started approximately 2 days ago. He has felt feverish over the previous 48 hours but did not check his temperature. He has had no other symptoms. He states that he bumped his shin on the bed frame last week and sustained a bruise but no apparent breaks in the skin. His vital signs at the clinic reveal a temperature of 38.3°C, pulse 102 beats per minute, blood pressure 11 0/72 mm Hg, and respiratory rate 20 breaths per minute. The physician diagnoses this patient with cellulitis. 

Mild superficial infections, such as those that present clinically with delayed wound healing or minimal cellulitis, may be treated with topical antimicrobial agents.37 Table 70-9 lists some frequently used systemic and topical antibiotics. 

Methicillin-resistant Staphylococcus aureus (MRSA) is a common hospital-acquired pathogen and is also increasing in the community. MRSA has presented a problem in the past because it required treatment with vancomycin. Community-acquired MRSA presents a major therapeutic challenge. MRSA can cause pneumonia, cellulitis, and other infections. Clinicians should be aware of the rate of hospital and community MRSA in your geographic area. New treatment options are available for MRSA. They include linezolid, tigecycline, and daptomycin. Prospective clinical trials have not demonstrated benefits of these agents over vancomycin.36-37... 

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